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Chronic wound management: A practice focused study

Dowsett, C. (2008). Chronic wound management: A practice focused study. (Unpublished Doctoral thesis, City University London)


This thesis is being submitted in fulfilment of the requirements of a degree of Doctor of Professional Practice. This Doctorate consists of five practice based elements: A preface, case study, review of the literature, research report and dissemination artefact. These five practice focused elements are all related to my present position as a Nurse Consultant in Tissue Viability, and to the care of patients with chronic wounds.

The preface sets out the starting point of the candidate and the rationale for the work undertaken. Each element of the Professional Doctorate will be outlined and the inter-relationship between each of these elements discussed. The case study is concerned with clinical practice and emphasises the knowledge and skills required to be a reflective practitioner. The study describes the case management of a patient referred to the tissue viability service with a leg ulcer associated with sickle cell disease. The Neuman Systems Model of Nursing (1989) and a case management approach to assessment and management using the SOAPIER format (Cox 1997) was utilized. The critical review of the literature evaluates the available literature pertaining to the use of antimicrobial therapy in wound management, focusing specifically on silver dressings. Clinical practice recommendations are made for the diagnosis and treatment of wound infection and appropriate use of topical antimicrobial dressings.

The research project examines the impact of delivering an educational programme utilising the concept of Wound Bed Preparation (WBP) and the associated TIME framework on community nurses wound care knowledge and practice. WBP has gained international recognition as a concept that can provide a structured approach to wound management. The TIME framework was developed in 2002 by the International Advisory Board for WBP, as a practical tool for implementing the concept of WBP in clinical practice. TIME is an acronym summarising the four main components of WBP:

• Tissue • Infection/inflammation • Moisture • Edge

An experimentai pre-test post-test design using repeat measures was used for the study. The results showed that community nurses wound care knowledge and practice both improved after the educational intervention, and this improvement was found to be statistically significant (p<0.001).

The dissemination artefact is made up of a number of publications and presentations from the work undertaken for this professional Doctorate.

Publication Type: Thesis (Doctoral)
Subjects: R Medicine > RZ Other systems of medicine
Departments: Doctoral Theses
School of Health & Psychological Sciences > School of Health & Psychological Sciences Doctoral Theses
School of Health & Psychological Sciences > Healthcare Services Research & Management
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